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Ischemic stroke
Original research
Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial
  1. Colin P Derdeyn1,
  2. David Fiorella2,
  3. Michael J Lynn3,
  4. Stanley L Barnwell4,
  5. Osama O Zaidat5,
  6. Philip M Meyers6,
  7. Y Pierre Gobin7,
  8. Jacques Dion8,
  9. Bethany F Lane3,
  10. Tanya N Turan9,
  11. L Scott Janis10,
  12. Marc I Chimowitz9,
  13. for the SAMMPRIS Trial Investigators
  1. 1Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Department of Neurosurgery, State University of New York, Stony Brook, New York, New York, USA
  3. 3Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
  4. 4Department of Neurological Surgery and the Dotter Interventional Institute, Oregon Health Sciences University, Portland, Oregon, USA
  5. 5Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  6. 6Department of Radiology, Columbia University, New York, New York, USA
  7. 7Department of Radiology, Cornell University, New York, New York, USA
  8. 8Department of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
  9. 9Department of Neurosciences, Medical University of South Carolina, Charleston,  South Carolina, USA
  10. 10National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr C P Derdeyn, Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, MO 010386, USA; derdeync{at}mir.wustl.edu

Abstract

Background and purpose To investigate the relationship between physician and site experience and the risk of 30 day hemorrhagic and ischemic strokes in the stenting arm of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial.

Methods Study records and an investigator survey were examined for physician and site related factors, including: number of Wingspan and aneurysm stents submitted for credentialing, number of study procedures performed in SAMMPRIS, years in practice after training, primary specialty, and site enrollment. Bivariate and multivariate analyses were performed to determine if these factors were associated with the 30 day rate of cerebrovascular events after angioplasty and stenting.

Results 213 patients underwent angioplasty alone (n=5) or angioplasty and stenting (n=208) with study devices by 63 interventionists at 48 sites. For credentialing, the median number of Wingspan and similar aneurysm stent cases submitted by study interventionists were 10 and 6, respectively. Interventionists with higher numbers (>10) of Wingspan cases submitted for credentialing tended to have higher rates of 30 day events (19.0% vs 9.9%) than those with <10 cases. High enrolling sites in the trial tended to have lower rates of hemorrhagic stroke (9.8% at sites enrolling <12 patients vs 2.7% at sites enrolling >12 patients).

Conclusions Interventionists credentialed with less Wingspan experience were not responsible for the high rate of periprocedural stroke in SAMMPRIS. Hemorrhagic stroke may be related to low enrollment in the trial but not previous Wingspan experience.

  • Stroke
  • Stent
  • Angioplasty

https://doi.org/10.1136/neurintsurg-2012-010504

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